计算机辅助诊断系统对甲状腺结节的诊断价值研究

目的比较计算机辅助诊断（CAD）系统与多名超声医师对甲状腺结节的诊断效能，初步探讨CAD软件的诊断价值及分析甲状腺结节超声特征对CAD软件及超声医师诊断的影响。 方法选取2016年2月至2018年6月电子科技大学医学院附属四川省肿瘤医院医学影像信息（PACS）系统中甲状腺结节灰阶超声图像50张，采用CAD软件及111名超声医师同时对50张甲状腺结节图像进行诊断。以病理结果为"金标准"分别计算CAD软件，准确率最高的高年资医师、准确率最高的低年资医师鉴别诊断甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值，并绘制受试者工作特征曲线（ROC曲线）；各组间准确率的比较采用McNemar检验，ROC曲线下面积的比较采用Z检验。 结果CAD软件、准确率最高的高年资医师、准确率最高的低年资医师诊断甲状腺结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为76.9%、87.5%、86.9%、77.8%、82.0%；86.9%、77.8%、76.9%、87.5%、82.0%；82.6%、70.4%、70.4%、82.6%、76%；CAD软件与高年资医师诊断准确率相同且均高于低年资医师，差异有统计学意义；CAD软件与高年资医师ROC曲线下面积一致且均大于低年资医师，但差异均无统计学意义（P均>0.05）。医师误诊的病例主要为桥本甲状腺炎以及微小低回声病灶伴点状强回声的甲状腺结节，而分布位置以及结节内粗大钙化灶伴后方宽大声影造成了CAD软件的误诊。 结论CAD软件诊断甲状腺结节的准确率与高年资医师一致，高于低年资医师；甲状腺结节的分布位置以及结节内粗大钙化灶伴后方宽大声影可能是影响CAD软件诊断准确性的因素；而桥本甲状腺炎以及微小低回声病灶伴点状强回声可能会影响超声医师对甲状腺结节的正确诊断。     

Diagnostic Performance of Ultrasound Computer-Aided Diagnosis Software Compared with That of Radiologists with Different Levels of Expertise for Thyroid Malignancy: A Multicenter Prospective Study

The aim of the work described here was to evaluate the diagnostic performance of ultrasound thyroid computer-aided diagnosis (CAD) software. This multicenter prospective study included 494 patients (565 thyroid nodules) who underwent surgery or biopsy after ultrasonography at four hospitals from January 2019 to September 2019. The diagnostic performance metrics of different readers were calculated and compared with the pathologic results. The sensitivity of CAD was outstanding and was equivalent to that of a senior radiologist (90.51% vs. 88.47%, p > 0.05). The area under the curve of CAD was equivalent to that of a junior radiologist (0.748 vs. 0.739, p > 0.05). However, the specificity was only 49.63%, which was lower than those of the three radiologists (75.56%, 85.93% and 90.37% for the junior, intermediate and senior radiologists, respectively). The diagnostic performance of the junior radiologist was significantly improved with the aid of CAD (junior + CAD). The sensitivity and area under the curve of junior + CAD were improved from 72.20% to 89.93% and from 0.739 to 0.816, respectively (both p values <0.05), and the positive predictive value, negative predictive value and κ coefficient improved from 76.3% to 78.6%, 82.0% to 86.8% and 0.394 to 0.511, respectively. Though specificity slightly decreased from 75.56% to 73.33%, the difference was not statistically significant (p > 0.05). In general, the clinical application value of CAD is promising, and its instrumental value for junior radiologists is significant.     

基于甲状腺成像报告和数据系统分类的计算机辅助诊断系统对甲状腺癌超声诊断的辅助价值

目的探讨基于甲状腺成像报告和数据系统（TI-RADS）分类的计算机辅助诊断（CAD）系统对超声医师诊断甲状腺癌的辅助价值。 方法收集2018年10月至2019年3月在国内5家医院的400例甲状腺结节超声图像进行多中心回顾性研究。采用由北京大学前沿交叉学科研究院研发的基于TI-RADS分类的CAD系统,超声医师诊断甲状腺癌的诊断模式分为无CAD模式和CAD模式,11名具有不同工作经验的超声医师（低年资超声医师4名,中年资超声医师4名,高年资超声医师3名）在上述2种模式下诊断甲状腺癌。比较2种诊断模式的诊断效能及读片时间：绘制CAD系统和超声医师诊断甲状腺癌的受试者工作特征（ROC）曲线,应用DeLong方法比较2种模式下曲线下面积（AUC）的差异;应用配对t检验比较2种模式的读片时间差异。 结果在CAD模式下,所有超声医师诊断甲状腺癌的AUC值较无CAD模式有显著提高［0.848（0.837~0.858） vs 0.800（0.788~0.812）］,差异具有统计学意义（P＜0.001）;敏感度从73.8%（95%CI：71.9%~75.6%）提升到82.7%（95%CI：81.0%~84.3%）,差异具有统计学意义（χ²=9.870,P＜0.001）;特异度从86.2%（84.7%~87.6%）提升到86.9%（85.4%~88.3%）,但差异无统计学意义（χ²=0.021,P=0.379）。进行亚组分析时,在CAD模式下,低年资超声医师和中年资超声医师诊断甲状腺癌的AUC值较无CAD模式有显著提高（0.840 vs 0.740;0.848 vs 0.814）,差异具有统计学意义（P＜0.001、=0.001）,但高年资超声医师诊断甲状腺癌的AUC值较无CAD模式无明显变化（0.859 vs 0.861,P=0.861）。在CAD模式下,所有超声医师的阅片时间较无CAD模式减少［（20.2±8.2）s vs（22.7±9.6）s］,差异具有统计学意义（t=-23.9,P＜0.001）。 结论CAD模式有助于低年资超声医师和中年资超声医师对甲状腺癌的诊断,同时缩短了诊断时间。     

不同影像学检查诊断卵巢肿瘤: Meta分析

目的 评价CEUS、增强MRI、功能性MRI和CT对卵巢肿瘤的诊断价值。方法 检索Embase、Medline 数据库,收集关于CEUS、增强MRI、功能性MRI及CT诊断卵巢肿瘤的文献资料。进行统计分析得到各组诊断性试验的合并敏感度、特异度及SROC曲线下面积（AUC）。采用Z检验比较组间独立诊断试验的诊断效能。结果 CEUS、增强MRI、功能性MRI和CT诊断卵巢恶性肿瘤的合并敏感度分别为0.89、0.93、0.83和0.88;合并特异度分别为0.91、0.90、0.79和0.91。四组影像学方法的AUC值分别为0.9619、0.9710、0.9090和0.9444。Z检验结果显示：CEUS、增强MRI、CT三者的诊断效能差异无统计学意义（P>0.05）;功能性MRI的诊断效能低于CEUS和增强MRI（P均<0.05）。结论 CEUS、增强MRI、功能性MRI和CT四种影像学方法对卵巢恶性肿瘤均具较高的诊断效能,对卵巢肿瘤的诊断各有优势和不足。     

S-Detect技术在不同级别超声医师乳腺肿物性质诊断的应用价值

目的探讨超声智能化诊断(S-Detect)技术在不同级别超声医师对乳腺肿物性质诊断的应用价值。方法选取在我院门诊行乳腺超声检查有乳腺肿块的患者168例,乳腺肿物共206个,其中将符合标准的168个乳腺肿物纳入研究。A组两名高级职称的超声医师和B组两名初级职称的超声医师分别用BI-RADS分类和S-Detect技术对乳腺肿物进行良恶性评估。所有肿物均经穿刺活检或手术取得病理结果为金标准。结果A组医师单独应用BI-RADS分类、S-Detect及联合应用两种诊断技术的灵敏度分别为81.25%、87.50%、93.75%,特异度分别为76.32%、79.60%、84.21%,准确度分别为76.79%、80.36%、85.12%,一致性检验Kappa值分别为0.30、0.37、0.48。B组医师单独应用BI-RADS分类、S-Detect及联合应用两种诊断技术的灵敏度分别为68.75%、75.00%、87.50%,特异度分别为65.79%、68.42%、82.89%,准确度分别为66.07%、69.04%、83.33%,一致性检验Kappa值分别为0.15、0.20、0.42。结论超声智能化诊断技术联合应用BI-RADS分类能提高高级职称医师和初级职称医师对乳腺肿物性质诊断的准确度及其一致性,其中对于初级超声医师对乳腺肿物性质诊断的辅助价值更明显。     

人工智能自动检测系统对不同经验医师诊断乳腺小肿块的辅助作用

目的初步探讨人工智能自动检测系统对乳腺小肿块的诊断效能以及对不同经验医师的辅助作用。 方法选取中国科学院大学宁波华美医院164个经病理证实的最大直径≤10 mm的乳腺小肿块,由4名不同经验的医师（医师A和医师B归为高年资医师组,医师C和医师D归为低年资医师组）先独立诊断,给出相应的乳腺影像报告与数据系统（BI-RADS）分类,结果设为A1组、B1组、C1组和D1组。4周后,4名医师再次联合应用人工智能自动检测系统诊断,结果设为A2组、B2组、C2组和D2组。人工智能自动检测系统诊断结果设为M组。以病理结果为金标准,计算不同组医师诊断的敏感度、特异度、准确性、阴性预测值和阳性预测值,绘制受试者操作特征曲线。采用Kappa检验比较不同组观察者间的一致性。 结果病理结果显示,164个乳腺肿块中良性117个（71.34%）,恶性47个（28.66%）。人工智能自动检测系统对乳腺小肿块有良好的诊断效能,敏感度、特异度、准确性分别为91.49%、90.6%、90.85%。联合应用人工智能自动检测系统后高年资医师的诊断效能有上升趋势,敏感度、特异度分别为A1组82.98%、82.05%;A2组87.23%、89.74%;B1组80.85%、84.62%;B2组85.11%、89.74%。低年资医师在人工智能自动检测系统的辅助下诊断效能明显提高,敏感度、特异度分别为C1组76.60%、74.36%;C2组82.98%、82.05%;D1组68.09%、73.50%;D2组80.85%、80.34%。此外低年资医师借助人工智能自动检测系统对乳腺小肿块BI-RADS分类的观察者间一致性明显提高,低年资医师间的Kappa值由0.236提高到0.549,低年资医师与高年资医师的Kappa值由0.268~0.284提高到0.432~0.540。 结论人工智能自动检测系统对乳腺小肿块良恶性的判断具有较高的诊断效能,其对不同经验医师的辅助作用不同,对低年资医师的影响大于高年资医师。人工智能自动检测系统有助于提高低年资医师BI-RADS分类观察者间的一致性。     

高分辨率T2WI联合合成双反转恢复图像判断直肠癌T分期北大核心CSCD

目的观察合成MRI(SyMRI)定量参数及高分辨率T2WI(HR-T2WI)联合合成双反转恢复(SyDIR)图用于直肠癌T分期的价值。方法回顾性分析79例经病理证实直肠腺癌,将病理T1及T2期归为肌层未突破组、T3及T4期归为肌层突破组。由2名影像科医师(分别具有低及高年资)基于HR-T2WI及联合SyDIR图行直肠癌T分期,观察其与病理结果的一致性,计算T分期诊断准确率;比较组间SyMRI定量参数值T1、T2及质子密度(PD)的差异。绘制受试者工作特征曲线,计算曲线下面积(AUC),评估HR-T2WI及其联合SyDIR图和T2值诊断直肠癌突破肌层的效能。结果79例中,病理T分期T1期3例,T2期32例,T3期27例,T4期17例。2名医师基于HR-T2WI判断直肠癌T分期与病理结果的一致性均较强(Kappa=0.626、0.784,P均<0.001),诊断准确率分别为75.95%(60/79)及86.08%(68/79);基于HR-T2WI联合SyDIR图判断直肠癌T分期与病理结果的一致性为较强及强(Kappa=0.783、0.829,P均<0.001),诊断准确率分别为84.81%(67/79)及88.61%(70/79)。低年资医师基于HR-T2WI联合SyDIR图判断直肠癌突破肌层的AUC(0.940)高于基于单一HR-T2WI(AUC=0.843,Z=2.443,P=0.015);高年资医师基于HR-T2WI联合SyDIR图的AUC(0.954)与基于单一HR-T2WI差异无统计学意义(AUC=0.943,Z=0.366,P=0.720),后者与低年资医师基于HR-T2WI联合SyDIR图差异无统计学意义(Z=0.108,P=0.918)。2名医师所测肌层未突破组T2值均高于肌层突破组(P均<0.001),其余定量参数差异均无统计学意义(P均>0.05);根据T2值判断直肠癌突破肌层的AUC为0.812。结论SyMRI定量参数T2值对判断直肠癌T分期具有一定价值;HR-T2WI联合SyDIR图有助于提高低年资影像科医师判断直肠癌T分期的效能。     

基于计算机辅助诊断技术的超声图像处理软件对甲状腺结节诊断效能的初步研究

目的通过比较基于计算机辅助诊断技术（CAD）的甲状腺超声图像处理软件（安克侦）与超声医师对甲状腺结节进行甲状腺影像报告和数据系统（TI-RADS）评分的差别,初步探讨安克侦CAD软件在甲状腺结节良恶性鉴别诊断中的价值。 方法选取2015年5月至2016年10月就诊于中山大学附属肿瘤医院的194例甲状腺结节患者的病例资料。每个病例选取一个结节进行分析,所有结节均经手术或超声引导下细针穿刺活检（US-FNA）病理证实。由两位年资不同的超声医师评估结节图像,分别对结节的5个特征（成分、回声、形态、边缘、强回声）进行评分,得出总的TI-RADS评分并分类。安克侦CAD软件则通过自动分析结节图像,得出基于美国放射学会（ACR）标准的TI-RADS评分。 结果安克侦CAD软件的TI-RADS评分与高年资医师比较,差异无统计学意义（Z=0.964,P=0.335）,与低年资医师比较,差异具有统计学意义（Z=5.593,P<0.001）。以TR5为恶性诊断界值,安克侦CAD软件的诊断敏感度与高年资医师比较,差异无统计学意义（84.62% vs 86.54%,P=0.815）,且其略高于低年资医师,但差异无统计学意义（84.62% vs 73.08%,P=0.052）。安克侦CAD软件、低年资医师、高年资医师评分的诊断特异度分别为65.56%、87.78%、82.22%,安克侦CAD软件明显低于低年资和高年资医师（65.56% vs 87.78%,χ²=12.893,P<0.01;65.56% vs 82.22%,P=0.004）。CAD软件的ROC曲线下面积均低于高年资及低年资医师（0.735 vs 0.921,Z=4.537,P<0.0001;0.735 vs 0.898,Z=4.033,P=0.0001）。 结论安克侦CAD软件对甲状腺结节的诊断敏感度与高年资及低年资医师相比,并无显著差异,但诊断特异度及诊断准确性均低于高年资及低年资医师。其综合诊断效能仍需进一步深入研究。     

Characterization and diagnostic confidence of contrast-enhanced ultrasound for solid renal tumors

The objective was to determine whether contrast-enhanced ultrasound (CEUS) could improve the diagnostic confidence of solid renal masses. CEUS examinations were performed on 51 patients with renal tumors. Histologic findings from surgical specimens (n = 24) or magnetic resonance imaging follow-up (n = 27) were used as reference procedures for definitive diagnosis. Diffuse heterogeneous/homogeneous enhancement and quick peripheralnodularenhancement were found to be characteristic patterns in renal cell carcinoma (RCC). Dotlike or diffuse heterogeneous/homogeneous enhancement and slow peripheral nodular enhancement were observed as typical enhancement patterns in angiomyolipoma. The results show that CEUS combined with conventional ultrasound significantly improves diagnostic confidence. The sensitivity for RCC diagnosis with this imaging approach was 86% and the specificity was 93%. Both positive and negative predictive values of detection were 90% and the overall accuracy was 90%.     

超声国际卵巢肿瘤研究组简单法则与妇科影像报告与数据系统分类诊断卵巢肿瘤的比较

目的 比较超声国际卵巢肿瘤研究组（IOTA）简单法则与妇科影像报告与数据系统（GI-RADS）诊断卵巢肿瘤的价值。方法 由高年资医师运用IOTA简单法则对463例卵巢肿瘤进行分类,将诊断为良性和恶性的卵巢肿瘤纳入研究。然后,由低年资和高年资医师在互不知道检查结果的情况下分别运用IOTA简单法则和GI-RADS分类进行诊断,定义低年资医师采用IOTA简单法则诊断为A1组,高年资医师采用IOTA简单法则诊断为B1组,低年资医师采用GI-RADS诊断为A2组,高年资医师采用GI-RADS诊断为B2组,比较两种方法的诊断效能。结果 463例病例中,高年资医师IOTA确认良性及恶性的卵巢肿瘤共411例（411/463,88.77%）,不能确定性质的52例（52/463,11.23%）。A2与B2组间、A1与A2组间特异度、阳性预测值和诊断正确率差异均有统计学意义（P均<0.05）,敏感度与阴性预测值差异无统计学意义（P均>0.05）。诊断效能各指标在A1与B1组间、B1与B2组间差异均无统计学意义（P均>0.05）。结论 IOTA简单法则和GI-RADS分类对卵巢良恶性肿瘤的诊断效能相当且均较高。IOTA简单法则不存在经验依赖性,但不适合全部卵巢肿瘤的评价。     

超声造影与MRI增强扫描对不确定性盆腔肿块良恶性判断的比较研究

目的 比较超声造影（CEUS）与MRI增强扫描对不确定性盆腔肿块良恶性的诊断价值。方法 对46例常规超声检查发现不确定性（使用国际卵巢肿瘤分析中的简易准则判断）盆腔肿块行实时CEUS以及MRI增强扫描检查,2名超声科医师及2名放射科医师在结合患者病史以及血清肿瘤标志物前后分别对检查结果独立作出诊断,以术后病理结果（n = 43）或临床治疗后的最终随访诊断结果（n = 3）作为金标准,对比结合病史及肿瘤标志物前后2种影像技术的诊断价值。结果 结合患者病史及肿瘤标志物前,CEUS对不确定性盆腔肿块的诊断准确度为67.4%,低于MRI增强扫描的80.4%,两者比较结果差异有统计学意义（P < 0.05）;结合病史和（或）结合肿瘤标志物后,2种影像技术对不确定性盆腔肿块的诊断准确度比较差异均无统计学意义（P均> 0.05）。CEUS结合患者病史和肿瘤标志物对不确定性盆腔肿块诊断准确度为91.3%,与不结合任何病史资料的CEUS比较差异有统计学意义（P < 0.05）。结论 在结合患者病史和血清肿瘤标志物的情况下,CEUS与MRI增强扫描对不确定性盆腔肿块的诊断准确度相当,CEUS对不确定性盆腔肿块的良恶性判断具有良好的临床应用价值。     

B-Mode Ultrasound Combined with Color Doppler and Strain Elastography in the Diagnosis of Non-mass Breast Lesions: A Prospective Study

Non-mass breast lesions on ultrasound (US) are areas without an associated mass. The purpose of this study was to evaluate whether combining B-mode US with color Doppler US and strain elastography (SE) improves US differentiation between benign and malignant non-mass breast lesions and the decision for biopsy. In this prospective study, three different radiologists analyzed the US images of 77 non-mass lesions independently and recorded Breast Imaging Reporting and Data System (BI-RADS) categories for four data sets. The image characteristics and BI-RADS categories of the four data sets were analyzed by another radiologist. The final diagnosis was made on the basis of pathologic findings. Values for area under the receiver operating curve (AUC), sensitivity, specificity and accuracy were compared among the data sets. The AUC of B-mode US combined with both color Doppler US and SE was greater than that of B-mode US alone (0.666 vs. 0.828) (p = 0.011). The specificity of making the decision for biopsy increased from 6.5% to 38.7% when B-mode US was combined with color Doppler and SE, without a statistically significant change in sensitivity (p < 0.001). Combined use of color Doppler and SE could improve the diagnostic value of B-mode US in distinguishing benign from malignant non-mass breast lesions and the specificity of making the decision for biopsy of non-mass breast lesions.     

Comparison of Strain and Shear Wave Elastography for the Differentiation of Benign From Malignant Breast Lesions,Combined With B-mode Ultrasonography: Qualitative and Quantitative Assessments

Our aim was to compare the diagnostic performance of strain elastography (SE) and shear-wave elastography (SWE), combined with B-mode ultrasonography (US), in breast cancer. For 79 breast lesions that underwent SE and SWE, two radiologists reviewed five data sets (B-mode US, SWE, SE and two combined sets). Qualitative and quantitative elastographic data and Breast Imaging Reporting and Data System (BI-RADS) categories were recorded. The area under the receiver operating characteristic curve (AUC) was evaluated. No significant difference in the AUC between the two elastography methods was noted. After subjective assessment by reviewers, the AUC for the combined sets was improved (SWE, 0.987; SE, 0.982; B-mode US, 0.970; p < 0.05). When SE and SWE were added, 38% and 56% of benign BI-RADS category 4a lesions with a low suspicion of cancer were downgraded without false-negative results, respectively. SE and SWE performed similarly. Therefore, addition of SE or SWE improved the diagnostic performance of B-mode US, potentially reducing unnecessary biopsies.     

Meta-Analysis: Contrast-Enhanced Ultrasound Versus Conventional Ultrasound for Differentiation of Benign and Malignant Breast Lesions

This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS), conventional ultrasound (US) combined with CEUS (US?+?CEUS) and US for distinguishing breast lesions. From thorough literature research, studies that compared the diagnostic performance of CEUS versus US or US?+?CEUS versus US, using pathology results as the gold standard, were included. A total of 10 studies were included, of which 9 compared the diagnostic performance of CEUS and US, and 5 studies compared US?+?CEUS and US. In those comparing CEUS versus US, the pooled sensitivity was 0.93 (95% CI: 0.91–0.95) versus 0.87 (95% CI: 0.85–0.90) and pooled specificity was 0.86 (95% CI: 0.84–0.88) versus 0.72 (95% CI: 0.69–0.75). In studies comparing US?+?CEUS versus US, the pooled sensitivity was 0.94 (95% CI: 0.92–0.96) versus 0.87 (95% CI: 0.84–0.90) and pooled specificity was 0.86 (95% CI: 0.82–0.89) versus 0.80 (95% CI: 0.76–0.84). In terms of diagnosing breast malignancy, areas under the curve of the summary receiver operating characteristic (of both CEUS (p?=?0.003) and US?+?CEUS (p?=?0.000) were statistically higher than that of US. Both CEUS alone and US?+?CEUS had better diagnostic performance than US in differentiation of breast lesions, and US?+?CEUS also had low negative likelihood ratio.     

超声造影对前列腺癌诊断价值的系统评价

目的 采用Meta分析评价CEUS诊断前列腺癌的临床价值。方法 检索和筛选英文和中文数据库中2012年10月以前文献进行数据提取和质量评价,对敏感度、特异度、似然比(LR)、诊断比值比(DOR)、汇总受试者工作特征(SROC)曲线进行拟合分析,获得SROC曲线下面积(AUC),评价发表偏倚。结果 纳入18篇文献(2714例患者),研究采用多种造影剂和成像模式,得出不同结果;合并敏感度、特异度、阳性LR、阴性LR和DOR分别为0.71、0.74、2.91、0.33和9.97,异质性的差异有统计学意义(P<0.01);AUC为0.84;Begg(P=0.85)和Egger检验(P=0.14)显示不存在显著的发表偏倚。结论 CEUS是诊断前列腺癌的有效方法,但不能取代前列腺系统穿刺活检;需要通过高质量、前瞻性研究制定相对规范和统一的CEUS操作方法、造影剂使用和诊断标准。     

超声造影与弹性成像联合评分对乳腺BI-RADS 4类病灶的应用价值

目的探讨超声造影（CEUS）与实时组织弹性成像（UE）联合评分对乳腺超声影像报告和数据系统（BI-RADS）诊断为4类的乳腺病灶的良恶性鉴别诊断价值。 方法选取2012年4月至2016年2月在浙江大学医学院附属第二医院常规超声检查且诊断为BI-RADS 4类的158例患者共172个乳腺病灶行CEUS及UE检查,分别对每个病灶进行赋值评分,以穿刺或手术病理为金标准,构建ROC曲线,分析CEUS和UE联合评分法对BI-RADS 4类病灶的良恶性鉴别诊断价值。 结果172个病灶中,病理学诊断良性80个,恶性92个,单独应用CEUS评分法分析乳腺BI-RADS 4类病灶的ROC曲线下面积（AUC）、敏感度、特异度、准确性分别为0.894、84.78%、85.00%、84.88%;单独应用UE评分法分析乳腺BI-RADS 4类病灶的ROC曲线下面积（AUC）、敏感度、特异度、准确性分别为0.844、82.61%、82.50%、82.56%。把造影和弹性评分法联合,以7分为诊断界点（AUC为0.951）,其敏感度、特异度、准确性为94.57%、93.75%、94.19%,均高于单独评分法（P<0.05）。 结论应用超声造影及弹性成像联合评分法能够明显提高乳腺BI-RADS 4类病灶的诊断准确率,可作为BI-RADS分类的补充,减少不必要的术前活检,值得临床推广应用。     

超声造影和增强CT诊断肝脏局灶性病变的Meta分析

目的 通过Meta分析比较超声造影(CEUS)和增强CT(CECT)对肝脏局灶性病变的诊断价值. 方法 检索PubMed和中国期刊网CNKI数据库关于CEUS及CECT诊断肝脏局灶性病变的中英文文献,并对文献进行评价和筛选.应用Metadisc软件对纳入的试验结果 进行分析. 结果 CEUS诊断肝脏局灶性病变共纳入2041例,合并敏感度为89.00%,合并特异度为88.00%,加权SROC曲线下面积(AUC)为0.9666.CECT诊断肝脏局灶性病变共纳入686例,合并敏感度为93.00%,合并特异度为84.00%,加权SROC曲线下面积(AUC)为0.9610. 结论 CEUS与CECT对肝脏局灶性病变诊断准确性差异无统计学意义.     

Diagnostic value of contrast-enhanced ultrasound, computed tomography and magnetic resonance imaging for focal liver lesions: a meta-analysis

The diagnostic performance of contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI) was determined in patients with focal liver lesions (FLLs) in a meta-analysis. Meta-Disc version 1.4 was used to describe and calculate sensitivity, specificity, summary receiver operating characteristic (SROC) curves and area under the curve (AUC). In the 25 included studies, the pooled estimate of CEUS studies for sensitivity, specificity and diagnostic odds ratio (DOR) was 87% (95% CI 85-88), 89% (95% CI 87-91) and 78.84 (95% CI 29.40-211.40), respectively. Sensitivity, specificity and DOR were 86% (95% CI 84-88), 82% (95% CI 77-86) and 26.34 (95% CI 8.32-83.39), respectively, for the CECT studies. Sensitivity, specificity and DOR were 85% (95% CI 82-88), 87% (95% CI 83-91) and 48.37 (95% CI 15.87-147.45), respectively, for the CEMRI studies. SROC analysis indicated that the diagnostic value of CEUS for FLLs is not significantly different from that of CECT and CEMRI.     

计算机辅助诊断系统在甲状腺结节超声诊断中的应用

[摘 要] 目的 评估计算机辅助诊断（Computer-aided Diagnosis ,CAD）系统在甲状腺超声检查中的诊断效能及临床应用价值。方法 选取2018年8月至2019年1月在中南大学湘雅三医院进行甲状腺超声检查并行手术切除的171例患者，共205个甲状腺结节。分别采用CAD及4名不同经验水平的超声医师对205例甲状腺结节的超声图像进行分析并根据美国放射学会（ACR）的TI-RADS指南进行分类，然后对4名不同经验水平的超声医师结合CAD也进行了研究。以手术病理结果为金标准,评估CAD系统在鉴别甲状腺良恶性结节中的诊断效能，以及CAD对不同经验水平的超声医师的影响。结果 CAD系统的使用提高了4名超声医师对甲状腺结节鉴别诊断的敏感性及AUC值(结合CAD系统vs未结合CAD系统:灵敏度：超声医师A, 93.10% vs 87.93%;超声医师B, 90.52% vs 84.48%;超声医师C, 85.34% vs 78.45%;超声医师D, 75.00% vs 66.38%，AUC值：超声医师A, 0.95 vs 0.94;超声医师B, 0.93 vs 0.92;超声医师C, 0.86vs 0.81;超声医师D, 0.86 vs 0.70)，差异均有统计学意义（P均＜0.05）。然而CAD系统的低特异性(73.03%)仅对超声医师C、D有显著性改善(P均＜0.05)。CAD系统对甲状腺恶性肿瘤的诊断敏感性与具有5年经验的超声医师相似，差异无统计学意义（P=1.00），但CAD系统的特异性较低。结论 CAD鉴别诊断甲状腺结节的敏感性较高，但特异性较低。结合CAD可有效提高初级医师甲状腺结节的超声诊断水平，也能提高高年资医师对甲状腺结节鉴别诊断的敏感性。     

超声造影联合声触诊组织成像定量技术诊断乳腺癌前哨淋巴结

目的 观察超声造影（CEUS）联合声触诊组织成像定量（VTIQ）技术诊断乳腺癌前哨淋巴结（SLN）的价值。方法 对37例经病理确诊乳腺癌患者行乳腺超声造影,追踪显像淋巴管,观察SLN增强模式,评价CEUS对SLN的检出率及定位及定性诊断准确率;采用VTIQ测量CEUS所见SLN的剪切波速度平均值（SWV_mean）。绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,判断VTIQ诊断SLN的效能;观察2种方法联合诊断SLN的价值。结果 CEUS对乳腺癌SLN的检出率为91.89%,判断其良恶性的敏感度为90.91%,特异度为51.72%,准确率为62.50%。SWV_mean诊断SLN的AUC为0.848,截断值取1.79 m/s时,敏感度、特异度及准确率分别为90.91%、68.97%及75.00%。CEUS和VTIQ联合诊断SLN良恶性淋巴结的敏感度、特异度及准确率为90.91%、75.86%及80.00%。结论 CEUS及VTIQ联合诊断乳腺癌SLN的效能较高。